mindfulness-based intervention for depression and insulin resistance in adolescents

Conditions: Type 2 Diabetes; Depression; Insulin Resistance; Obesity; Adolescent Development

Summary: rates of type 2 diabetes (t2d) in adolescents have escalated. adolescent-onset is associated with greater health comorbidities and shorter life expectancy than adult-onset t2d. t2d is preventable by decreasing insulin resistance, a physiological precursor to t2d. t2d prevention standard-of-care is lifestyle intervention to decrease insulin resistance through weight loss; yet, this approach is insufficiently effective in adolescents. adolescents at risk for t2d frequently experience depression, which predicts worsening insulin resistance and t2d onset, even after accounting for obesity. mindfulness-based intervention (mbi) may offer a targeted, integrative health approach to decrease depression, and thereby, ameliorate insulin resistance in adolescents at risk for t2d. in a single-site, pilot randomized controlled trial (rct), we established initial feasibility/acceptability of a 6-week group mbi program, learning to breathe, in adolescents at risk for t2d. we demonstrated feasible single-site recruitment, randomization, retention, protocol adherence, and mbi acceptability/credibility in the target population. our preliminary data also suggest mbi may lead to greater reductions in stress-related behavior, vs. cbt and a didactic/health education (healthed) control group. the current study is multisite, pilot rct to test multisite fidelity, feasibility, and acceptability in preparation for a future multisite efficacy trial that will have strong external validity, timely recruitment, and long-term follow-up. adolescents (n=120) at risk for t2d will be randomized to mbi vs. cbt vs. healthed and followed for 1-year. specific aims are to: (1) test multisite fidelity of training and implementation of 6-week group mbi, cbt, and healthed, to teens at risk for t2d; (2) evaluate multisite feasibility/acceptability of recruitment, retention, and adherence for an rct of 6-week group mbi, cbt, healthed with 6-week and 1-year follow-up; and (3) modify intervention training/implementation and protocol procedures in preparation for a future, fully-powered multisite efficacy rct.


Eligibility criteria:
inclusion criteria: * adolescent: age 12-17 years * at-risk for t2d: overweight/obesity: bmi ≥85 percentile for age and sex family history of t2d: ≥1 relative with t2d, prediabetes, or gestational diabetes in first- or second- degree relative, referring to a biological parent, sibling, aunt, uncle, or grandparent * elevated depression symptoms: center for epidemiological studies - depression scale (ces-d) total score \>20 * good general health: medical history/physical examination * parent/guardian: parent/guardian of qualifying participant exclusion criteria: * major medical problem: including t2d, assessed at baseline/screening as fasting glucose ≥126 mg/dl or 2-hour glucose ≥200 mg/dl, or any other significant medical condition reported during the medical history/physical examination * major psychiatric problem: diagnostic and statistical manual of mental disorders (dsm)-5 psychiatric diagnosis, including anorexia nervosa, bipolar disorder, bulimia nervosa, conduct disorder, major depressive disorder (mdd), obsessive compulsive disorder, panic disorder, posttraumatic stress disorder, psychosis, and substance/tobacco/alcohol use disorder * regular medication use affecting mood, insulin, and/or weight: anti-anxiety medications, anti-depressants, anti-psychotics, insulin sensitizers, mood stabilizers, stimulants, and weight loss drugs * active suicidal ideation or behavior * regular psychotherapy or structured weight loss treatment * pregnancy: as reported by adolescent participants (females)

Keywords: adolescent development obesity type 2 diabetes